Provider Demographics
NPI:1265788855
Name:BAEZ VALLECILLO, LUIS (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:BAEZ VALLECILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:
Other - Last Name:BAEZ VALLECILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:97 AVE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6310
Mailing Address - Country:US
Mailing Address - Phone:787-919-7919
Mailing Address - Fax:787-919-7918
Practice Address - Street 1:97 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6310
Practice Address - Country:US
Practice Address - Phone:939-545-6353
Practice Address - Fax:939-545-6354
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19615207R00000X, 207RH0003X
TXP6580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine